Over the past years important progress has been made in the diagnostic approach of suspicious breast lesions. According to worldwide standards of care, breast centers should investigate all lesions classified as suspicious for malignancy (BI-RADS 4 and 5) by a percutaneous biopsy and plan open surgical biopsies only when a percutaneous biopsy is not technically feasible. The radiologist must choose what type of biopsy should be used among different types according to what best suits each case. The factors considered to determine what is the appropriate type of biopsy are: the size of the lesion, the morphology and the texture of the lesion, the anatomical localization, the size of the breasts, if the lesion is palpable or not, and if it is recognized on mammography or ultrasound or only in one of the two examinations for example if it concerns a solid lesion or microcalcifications.
Fine needle aspiration (FNA)
Fine needle aspiration uses precisely what its name indicates, i.e. a fine needle, to remove fluid from a cyst or to obtain cells from a solid lesion. If the lesion is not palpable, ultrasound or mammography are used to ensure that, while taking the material, the tip of the needle is within the lesion. This is a completely painless, quick and easy technique without the risk of complications. The main drawback of the method is its low diagnostic reliability, which ranges from 70%-96%. This means that doctors cannot rely on the outcome of the examination if the result is negative, but only if it is positive for malignancy.
The Core Biopsy technique, which is applied to both palpable and non-palpable lesions, receives tissue blocks from the suspected area under local anaesthesia. As with aspiration if the lesion is not palpable, Core Biopsy is guided by ultrasound or using a special mammography system – stereotactic system. This technique is applied to obtain histological diagnoses on lesions shown on mammography or ultrasound that would otherwise warrant surgical biopsy. Four to five tissue blocks are received for each lesion and are sent for histological examination.
The histological results of Core Biopsy are accurate and reliable as those of open surgical biopsies.
Advantages of the method
- The examination takes about half an hour.
- No hospitalization is required.
- The examinee does not receive general anaesthesia and can immediately return home.
- Unnecessary surgical operations are avoided.
- If the biopsy result is positive for breast malignancy, it helps the surgeon to plan the appropriate surgical approach.
- It allows the patient and doctor to agree on the most appropriate treatment in case the biopsy result is positive.